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Full text of "Ancient Classic Texts before 400 B.C."

Instruments of Reduction 
By Hippocrates 



Translated by Francis Adams 



PART 1 

With regard to the construction of bones, the bones and joints of 

the fingers are simple, the bones of the hand and foot are numerous, 

and articulated in various ways; the uppermost are the largest; the 

heel consists of one bone which is seen to project outward, and the 

back tendons are attached to it. The leg consists of two bones, united 

together above and below, but slightly separated in the middle; the 

external bone (fibula), where it comes into proximity with the little 

toe, is but slightly smaller than the other, more so where they are 

separated, and at the knee, the outer hamstring arises from it; these 

bones have a common epiphysis below, with which the foot is moved, 

and another epiphys is above, * in which is moved the articular extremity 

of the femur, which is simple and light in proportion to its length, 

in the form of a condyle, and having the patella (connected with it?), 

the femur itself bends outward and forward; its head is a round epiphysis 

which gives origin to ligament inserted in the acetabulum of the hip-joint. 

This bone is articulated somewhat obliquely, but less so than the 

humerus. The ischium is united to the great vertebra contiguous to 

the os sacrum by a cartilaginous ligament. The spine, from the os 

sacrum to the great vertebra, is curved backward; in this quarter 

are situated the bladder, the organs of generation, and the inclined 

portion of the rectum; from this to the diaphragm it proceeds in a 

straight line inclining forward, and the psoae are situated there; 

from this point, to the great vertebra above the tops of the shoulders, 

it rises in a line that is curved backward, and the curvature appears 

greater than it is in reality, for the posterior processes of the 

spine are there highest; the articulation of the neck inclines forward. 

The vertebrae on the inside are regularly placed upon one another, 

but behind they are connected by a cartilaginous ligament; they are 

articulated in the form of synarthrosis at the back part of the spinal 

marrow; behind they have a sharp process having a cartilaginous epiphysis, 

whence proceeds the roots of nerves running downward, as also muscles 

extending from the neck to the loins, and filling the space between 

the ribs and the spine. The ribs are connected to all the intervertebral 

spaces on the inside, from the neck to the lumbar region, by a small 

ligament, and before to the sternum, their extremities being spongy 

and soft; their form is the most arched in man of all animals; for 

in this part, man is, of all animals, the narrowest in proportion 

to his bulk. The ribs are united to each vertebra by a small ligament 

at the place from which the short and broad lateral processes (transverse 

processes?) arise. The sternum is one continuous bone, having lateral 

pits for the insertion of the ribs; it is of a spongy and cartilaginous 

structure. The clavicles are rounded in front, having some slight 

movements at the sternum, but more free at the acromion. The acromion, 

in man, arises from the scapula differently from most other animals. 

The scapula is cartilaginous toward the spine, and spongy elsewhere, 

having an irregular figure externally; its neck and articular cavity 

cartilaginous; it does not interfere with the movements of the ribs, 

and is free of all connection with the other bones, except the humerus. 

The head of the humerus is articulated with its (glenoid?) cavity, 

by means of a small ligament, and it consists of a rounded epiphysis 

composed of spongy cartilage, the humerus itself is bent outward and 

forward, and it is articulated with its (glenoid?) cavity by its side, 

and not in a straight line. At the elbow it is broad, and has condyles 

and cavities, and is of a solid consistence; behind it is a cavity 



in which the coronoid process (olecranon?) of the ulna is lodged, 
when the arm is extended; here, too, is inserted the benumbling nerve, 
which arises from between the two bones of the forearm at their junction, 
and terminates there. 

* Epiphysis means a close union of the two bones by means of a ligament. 



PART 2 

When the nose is fractured, the parts should be modeled instantly, 
if possible. If the fracture be in its cartilaginous part, introduce 
into the nostrils a tent formed of caddis, inclosed in the outer skin 
of a Carthaginian hide, or anything else which does not irritate; 
the skin is to be glued to the parts displaced, which are to be thus 
rectified. Bandaging in this case does mischief. The treatment is 
to consist of flour with manna, or of sulphur with cerate. You will 
immediately adjust the fragments, and afterward retain them in place 
with your fingers introduced into the nostrils, and turning the parts 
into place; then the Carthaginian skin is to be used. Callius forms 
even when there is a wound; and the same things are to be done, even 
when there is to be exfoliation of the bones, for this is not of a 
serious nature. 



PART 3 

In fractures of the ears, neither bandages nor cataplasms should be 

used; or, if any bandage be used, it should be put on very tight; 

the cerate and sulphur should be applied to agglutinate the bandages. 

When matter forms in the ears, it is found to be more deeply seated 

than might be supposed, for all parts that are pulpy, and consist 

of juicy flesh, prove deceptious in such a case. But no harm will 

result from making an opening, for the parts are lean, watery, and 

full of mucus. No mention is here made of the places and circumstances 

which render it fatal to make an opening. The cure is soonest effected 

by transfixing the ear with a cautery; but the ear is maimed and diminished 

in size, if burned across. If opened, one of the gentle medicines 

for flesh wounds should be used as a dressing. 



PART 4 

The jaw-bone is often slightly displaced (subluxated?) , and is restored 
again; it is dislocated but rarely, especially in gaping; in fact, 
the bone is never dislocated unless it slips while the mouth is opened 
wide. It slips, however, the more readily from its ligaments being 
oblique, supple, and of a yielding nature. The symptoms are: the lower 
jaw protrudes, it is distorted to the side opposite the dislocation, 
and the patient cannot shut his mouth; when both sides are dislocated, 
the jaw projects more, the mouth can be less shut, but there is no 
distortion; this is shown by the rows of the teeth in the upper and 
lower jaw corresponding with one another. If, then, both sides be 
dislocated, and not immediately reduced, the patient for the most 
part dies on the tenth day, with symptoms of continued fever, stupor, 
and coma, for the muscles there induce such effects; there is disorder 
of the bowels attended with scanty and unmixed dejection; and the 
vomitings, if any, are of the same character. The other variety is 
less troublesome. The method of reduction is the same in both: -The 
patient being laid down or seated, the physician is to take hold of 
his head, and grasping both sides of the jaw-bone with both hands, 



within and without, he must perform three manoeuvres at once, -rectify 
the position of the jaw, push it backward, and shut the mouth. The 
treatment should consist of soothing applications, position, and applying 
a suitable bandage to support the jaw-bone, so as to cooperate with 
the reduction. 



PART 5 

The bone of the shoulder is dislocated downward. I have never heard 

of any other mode. The parts put on the appearance of dislocation 

forward, when the flesh about the joint is wasted during consumption, 

as also seems to be the case with cattle when in a state of leanness 

after winter. Those persons are most liable to dislocations who are 

thin, slender, and have humidities about their joints without inflammation, 

for it knits the joints. Those who attempt to reduce and rectify dislocations 

in oxen, commit a blunder, as forgetting that the symptoms arise from 

the manner in which the ox uses the limb, and that the appearance 

is the same in a man who is in a similar condition, and forgetting 

also that Homer has said, that oxen are most lean at that season. 

In this dislocation, then, when not reduced, the patient cannot perform 

any of those acts which others do, by raising the arm from the side. 

I have thus stated who are the persons most subject to this dislocation, 

and how they are affected. In congenital dislocations the nearest 

bones are most shortened, as is the case with persons who are weasel-armed; 

the fore-arm less so, and the hand still less; the bones above are 

not affected. And the parts (near the seat of the injury) are most 

wasted in flesh; and this happens more especially on the side of the 

arm opposite the dislocation, and that during adolescence, yet in 

a somewhat less degree than in congenital cases. The deep-seated suppurations 

occur most frequently to new-born infants about the joint of the shoulder, 

and these produce the same consequences as dislocations. In adults, 

the bones are not so diminished in size, and justly, seeing that the 

others will not increase as in the former case; but wasting of the 

flesh takes place, for it is increased, and is diminished every day, 

and at all ages. And attention should be paid to the force of habit, 

and to the symptom produced by the tearing away of the acromion, whereby 

a void is left, which makes people suppose that the humerus is dislocated. 

The head of the humerus is felt in the armpit, and the patient cannot 

raise his arm, nor swing it to this side and that, as formerly. The 

other shoulder shows the difference. Modes of reduction : -The patient 

himself having placed his fist in the arm pit, pushes up the head 

of the humerus with it, and brings the hand forward to the breast. 

Another : -Force it backward, so that you may turn it round. Another : -Apply 

your head to the acromion, and your hands to the armpit, separate 

the head of the humerus (from the side?), and push the elbow in the 

opposite direction; or, instead of your knees, another person may 

turn aside the elbow, as formerly directed. Or, place the patient 

on your shoulder, with the shoulder in his armpit. Or, with the heel, 

something being introduced to fill up the hollow of the armpit, and 

using the right foot to the right shoulder. Or, with a pestle. Or, 

with the step of a ladder. Or, by rotation made with piece of wood 

stretched below the arm. Treatment : -As to attitude, the arm placed 

by the side, the hand and shoulder raised; the bandaging and adjustment 

of the parts while in this attitude. If not reduced, the top of the 

shoulder becomes attenuated. 



PART 6 

When the acromion is torn away, the appearance is the same as in dislocation 
of the shoulder; but there is no impediment, except that the bone 



does not return to its position. The figure should be the same as 
in dislocation, both as regards bandaging and suspending the limb. 
The bandaging according to rule. 



PART 7 

When partial displacement (sub-luxation?) takes place at the elbow, 
either inside or outside, but the sharp point (olecranon?) remains 
in the cavity of the humerus, make extension in a straight line, and 
push the projecting parts backward and to the sides. 



PART 8 

In complete dislocations to either side, make extension while the 
arm is in the position it is put in to be bandaged for a fracture, 
for thus the rounded part of the elbow will not form an obstacle to 
it. Dislocation most commonly takes place inward. The parts are to 
be adjusted by separating the bones as much as possible, so that the 
end of the humerus may not come in contact with the olecranon, but 
it is to be carried up and turned round, and not forced in a straight 
line; at the same time the opposite sides are to be pushed together, 
and the bones reduced to their place. In these cases rotation of the 
elbow cooperates; that is to say, turning the arm into a state of 
supination and pronation; so much for the reduction. With regard to 
the attitude in which it is to be put, -the hand is to be placed somewhat 
higher than the elbow, and the arm by the side; this position suits 
with it when slung from the neck, is easily borne, is its natural 
position, and one adapted for ordinary purposes, unless callus form 
improperly: the callus soon forms. Treatment : -By bandages according 
to the common rule for articulations, and the point of the elbow is 
to be included in the bandage. 



PART 9 

The elbow, when luxated, induces the most serious consequences, fevers, 
pain, nausea, vomiting of pure bile; and this especially in dislocations 
backward, from pressure on the nerve which occasions numbness; next 
to it is dislocation forward. The treatment is the same. The reduction 
of dislocation backward is by extension and adaptation: the symptom 
of this variety, loss of the power of extension; of dislocation forward, 
loss of the power of flexion. In it a hard ball is to be placed in 
the bend of the elbow, and the fore-arm is to be bent over this while 
sudden extension is made. 



PART 10 

Diastasis of the bones may be recognized by examining the part where 
the vein which runs along the arm divides. 



PART 11 

In these cases callus is speedily formed. In congenital dislocations, 
the bones below the seat of the injury are shorter than natural; in 
this case, the greatest shortening is in the nearest, namely, those 



of the fore-arm; second, those of the hand; third, those of the fingers. 
The arm and shoulders are stronger, owing to the nourishment which 
they receive, and the other arm, from the additional work it has to 
perform, is still more strong. The wasting of the flesh, if the dislocation 
was outward, is on the inside; or if otherwise, on the side opposite 
the dislocation. 



PART 12 

In dislocation at the elbow, whether outward or inward, extension 

is to be made with the fore-arm at right angles to the arm; the arm 

is to be suspended by a shawl passed through the armpit, and a weight 

is to be attached to the extremity of the elbow; or force is to be 

applied with the hands. The articular extremity being properly raised, 

the parts are to be adjusted with the palms of the hands, as in dislocations 

of the hands. It is to be bandaged, suspended in a sling, and placed, 

while in this attitude. 



PART 13 

Dislocations backward are to be rectified with the palms of the hands 
along with sudden extension. These two acts are to be performed together, 
as in other cases of the kind. In dislocation forward, the arm is 
to bend around a ball of cloth, of proper size, and at the same time 
replaced. 



PART 14 

If the displacement be on the other side both these operations are 

to be performed in effecting the adjustment of the arm. With regard 

to the treatment, -the position and the bandaging are the same as in 

the other cases. For all these cases may be reduced by ordinary distention. 



PART 15 

With regard to the modes of reduction, some act upon the principle 
of carrying the one piece of bone over the other, some by extension, 
and some by rotation: these last consist in rapidly turning the arm 
to this side and that. 



PART 16 



The joint of the hand is dislocated inward or outward, but most frequently 

inward. The symptoms are easily recognized; if inward, the patient 

cannot at all bend his fingers, but if outward, he cannot extend them. 

Reduction : -By placing the fingers above a table, extension and counter-extension 

are to be made by assistance, while, with the palm of the hand or 

the heel on the projecting bone, one presses forward, and from behind, 

upon the other bone, and lays some soft substance on it; and, if the 

dislocation be above, the hand is to be turned into a state of pronation; 

or, if backward, into a state of supination. The treatment is to be 

conducted with bandages. 



PART 17 

The whole hand is dislocated either inward, or outward, but especially 

inward, or to this side or that. Sometimes the epiphysis is displaced, 

and sometimes there is displacement (diastasis) of the one bone from 

the other. Powerful extension is to be made in this case; and the 

projecting part is to be pressed upon, and counter-pressure made on 

the opposite side: both modes being performed at the same time, both 

backward and laterally, either with the hands on a table, or with 

the heel. These accidents give rise to serious consequences and deformities; 

but in time the parts get so strong as to admit of being used. The 

treatment consists of bandages comprehending the hand and forearm, 

and splints are to be applied as far as the fingers; when put in splints, 

they are to be more frequently loosed than in fractures, and more 

copious allusions of water are to be used. 



PART 18 

In congenital dislocations the hand becomes shortened, and the atrophy 
of the flesh is generally on the side opposite the dislocation. In 
the adult the bones remain of their proper size. 



PART 19 

The symptoms of dislocation of the finger are obvious, and need not 

be described. This is the mode of reduction : -By stretching in a straight 

line, and making pressure on the projecting part, and counter-pressure, 

at the opposite side, on the other. The proper treatment consists 

in the application of bandages. When not reduced, the parts unite 

by callus outside of the joints. In congenital dislocations, and in 

those which occur during bones below the dislocation are shortened, 

and the flesh is wasted principally on the side opposite to the dislocation; 

in the adult the bones remain of their proper size. 



PART 2 

Dislocation at the hip-joint occurs in four modes, inward most frequently, 
outward next, the others of equal frequency. The symptoms : -The common, 
a comparison with the sound leg. The peculiar symptoms of dislocations 
inward; the head of the bone is felt at the perineum; the patient 
cannot bend his leg as formerly; the limb appears elongated, and to 
a great extent, unless you bring both limbs into the middle space 
between them in making a comparison of them; and the foot and the 
knee are inclined outward. If the dislocation has taken place from 
birth, or during one's growth, the thigh is shortened, the leg less 
so, and the others according to the same rule; the fleshy parts are 
atrophied, especially on the outside. Such persons are afraid to stand 
erect, and crawl along on the sound limb; or, if compelled, they walk 
with one or two staves, and bear up the affected limb; and the smaller 
the limb so much the more do they walk. If the accident happens to 
adults the bones remain of their proper size, but the flesh is wasted, 
as formerly described; the patients walk in a wriggling manner, like 
oxen; they are bent toward the flank, and the buttock on the uninjured 
side is prominent; for the uninjured limb must necessarily come below 
that it may support the body, whilst the other must be carried out 
of the way, as it cannot support the body, like those who have an 
ulcer in the foot. They poise the body by means of a staff on the 



sound side, and grasp the affected limb with the hand above the knee 

so as to carry the body in shifting from one place to another. If 

the parts below the hip-joint be used, the bones below are less atrophied, 

but the flesh more. 



PART 21 

The symptoms and attitudes in dislocation outward are the opposite, 
and the knee and foot incline a little inward. When it is congenital, 
or occurs during adolescence, the bones do not grow properly; according 
to the same rule, the bone of the hip-joint is somewhat higher than 
natural, and does not grow proportionally. In those who have frequent 
dislocations outward, without inflammation, the limb is of a more 
humid (flabby?) temperament than natural, like the thumb, for it is 
the part most frequently dislocated, owing to its configuration; in 
what persons the dislocation is to a greater or less extent; and in 
what persons it is more difficultly or easily produced; in what there 
is reason to hope that it can be speedily reduced, and in what not; 
and the remedy for this; and in what cases the dislocation frequently 
happens, and treatment of this. In dislocation outward from birth, 
or during adolescence, or from disease, (and it happens most frequently 
from disease, in which case there is sometimes exfoliation of the 
bone, but even where there is no exfoliation) , the patients experience 
the same symptoms, but to an inferior degree to those in dislocations 
inward, if properly managed so that in walking they can put the whole 
foot to the ground and lean to either side. The younger the patient 
is, the greater care should be bestowed on him; when neglected, the 
case gets worse; when attended to, it improves; and, although there 
be atrophy in all parts of the limb, it is to a less extent. 



PART 2 2 

When there is a dislocation on both sides, the affections of the bones 
are the same; the flesh is well developed, except within, the nates 
protrude, the thighs are arched, unless there be sphacelus. If there 
be curvature of the spine above the hip-joint, the patients enjoy 
good health, but the body does not grow, with the exception of the 
head. 



PART 2 3 

The symptoms of dislocation backward are: -The parts before more empty, 
behind they protrude, the foot straight, flexion impossible, except 
with pain, extension least of all: in these the limb is shortened. 
They can neither extend the limb at the ham, nor at the groin, unless 
it be much raised, nor can they bend it. The uppermost joint, in most 
cases, takes the lead: this is common in joints, nerves, muscles, 
intestines, uteri, and other parts. There the bone of the hip-joint 
is carried backward to the nates, and on that account it is shortened, 
and because the patient cannot extend it. The flesh of the whole leg 
is wasted in all cases, in which most, and to what extent, has been 
already stated. Every part of the body which performs its functional 
work is strong, but, not withstanding, if inactive, it gets into a 
bad condition, unless its inactivity arise from fatigue, fever, or 
inflammation. And in dislocations outward, the limb is shortened, 
because the bone is lodged in flesh which yields; but, not withstanding, 
in dislocations inward, it is longer, because the bone is lodged on 
a projecting bone. Adults, then, who have this dislocation unreduced, 



are bent at the groins in walking, and the other ham is flexed; they 
scarcely reach the ground with the ball of the foot; they grasp the 
limb with the hand, and walk without a staff if they choose; if the 
staff be too long, their foot cannot reach the grounds-if they wish 
to reach the ground, they must use a short staff. There is wasting 
of the flesh in cases attended with pain; and the inclination of the 
leg is forward, and the sound leg in proportion. In congenital cases, 
or when in adolescence, or from disease, the bone is dislocated (under 
what circumstances will be explained afterward) , the limb is particularly 
impaired, owing to the nerves and joints not being exercised, and 
the knee is impaired for the reasons stated. These persons, keeping 
the limb bent, walk with one staff or two. But the sound limb is in 
good flesh from usage. 



PART 2 4 

In dislocations forward the symptoms are the opposite: a vacuity behind, 
a protuberance before; of all motions they can least perform flexion, 
and extension best; the foot is straight, the limb is of the proper 
length at the heel; at its extremity the foot a little turned up; 
they are especially pained at first: of all these dislocations retention 
of urine occurs most frequently in this variety, because the bone 
is lodged among important nerves. The fore parts are stretched, do 
not grow, are diseased, and are obnoxious to premature decay; the 
back parts are wrinkled. In the case of adults, they walk erect, resting 
merely on the heel, and this they do decidedly if they can take great 
steps; but they drag it along; the wasting is least of all in this 
variety of dislocation, owing to their being able to use the limb, 
but the wasting is most behind. The whole limb being straighter than 
natural they stand in need of a staff on the affected side. When the 
dislocation is congenital, or has occurred during adolescence, if 
properly managed, the patient has the use of the limb as well as adults 
(otherwise?) have of it. But, if neglected, it is shortened and extended, 
for in such cases the joint is generally in a straight position. The 
diminution of the bones, and wasting of the fleshy parts, are analogous. 



PART 2 5 

In reduction-the extension of the thigh is to be powerful, and the 
adjustment what is common in all such cases, with the hands, or a 
board, or a lever, which, in dislocations inward, should be round, 
and in dislocations outward, flat; but it is mostly applicable in 
dislocations outward. Dislocations inward are to be remedied by means 
of bladders, extending to the bare part of the thigh, along with extension 
and binding together of the limbs. The patient may be suspended, with 
his feet a little separated from one another, and then a person inserting 
his arm within the affected limb, is to suspend himself from it, and 
perform extension and readjustment at the same time; and this method 
is sufficient in dislocations forward and the others, but least of 
all in dislocations backward. A board fastened under the limb, like 
the board fastened below the arm in dislocations at the shoulder, 
answers in dislocations inward, but less so in the other varieties. 
Along with extension you will use pressure either with the foot, the 
hand, or a board, especially in dislocations forward and backward. 



PART 2 6 

Dislocations at the knee are of a milder character than those of the 



elbow, owing to the compactness and regularity of the joint; and hence 

it is more readily dislocated and reduced. Dislocation generally takes 

place inward, but also outward and backward. The methods of reduction 

are-by circumf lexion, or by rapid excalcitration, or by rolling a 

fillet into a ball, placing it in the ham, and then letting the patient's 

body suddenly drop down on his knees: this mode applies best in dislocations 

backward. Dislocations backward, like those of the elbows, may also 

be reduced by moderate extension. Lateral dislocations may be reduced 

by circumf lexion or excalcitration, or by extension (but this is most 

applicable in dislocation backward), but also by moderate extension. 

The adjustment is what is common in all. If not reduced, in dislocations 

backward, they cannot bend the leg and thigh upon one another, but 

neither can they do this in the others except to a small extent; and 

the fore parts of the thigh and leg are wasted. In dislocations inward 

they are bandy-legged, and the external parts are atrophied. But, 

in dislocations outward, they incline more outward, but are less lame, 

for the body is supported on the thicker bone, and the inner parts 

are wasted. The consequences of a congenital dislocation, or one occurring 

during adolescence, are analogous to the rule formerly laid down. 



PART 2 7 

Dislocations at the ankle-joint require strong extension, either with 
the hands or some such means, and adjustment, which at the same time 
effects both acts; this is common in all cases. 



PART 2 8 

Dislocations of the bones of the foot are to be treated like those 
of the hand. 



PART 2 9 

Dislocations of the bones connected with the leg, if not reduced, 
whether occurring at birth or during adolescence, are of the same 
character as those in the hand. 



PART 30 

Persons who, in jumping from a height, have pitched on the heel, so 

as to occasion diastasis (separation) of the bones, ecchymosis of 

the veins, and contusion of the nerves, -when these symptoms are very 

violent, there is danger that the parts may sphacelate, and give trouble 

to the patient during the remainder of his life; for these bones are 

so constructed as to slip past one another, and the nerves communicate 

together. And, likewise in cases of fracture, either from an injury 

in the leg or thigh, or in paralysis of the nerves connected with 

these parts, or, when in any other case of confinement to bed the 

heel, from neglect, becomes blackened, in all these cases serious 

effects result therefrom. Sometimes, in addition to the sphacelus, 

very acute fevers supervene, attended with hiccup, tumors, aberration 

of intellect, and speedy death, along with lividity of the large bloodvessels, 

and gangrene. The symptoms of the exacerbations are these: if the 

ecchymosis, the blackened parts, and those around them, be somewhat 

hard and red, and if lividity be combined with the hardness, there 

is danger of mortification; but, not withstanding, if the parts are 



sublivid, or even very livid and diffused, or greenish and soft, these 

symptoms, in all such cases, are favorable. The treatment consists 

in the administration of hellebore, if they be free from fever, but 

otherwise, they are to have oxyglyky for drink, if required. Bandaging, - 

agreeably 

to the rule in other joints; but this is to be attended to also, -the 

bandages should be numerous, and softer than usual; compression less; 

more water than usual to be used in the allusions; to be applied especially 

to the heel. The same object should be sought after in the position 

as in the bandaging, namely, that the humors may not be determined 

to the heel; the limb to be well laid should have the heel higher 

than the knee. Splints not to be used. 



PART 31 

When the foot is dislocated, either alone, or with the epiphysis, 

the displacement is more apt to be inward. If not reduced, in the 

course of time the parts of the hips, thigh, and leg, opposite the 

dislocation, become attenuated. Reduction : -As in dislocation at the 

wrist; but the extension requires to be very powerful. Treatment : -Agreeably 

to the rule laid down for the other joints. Less apt to be followed 

by serious consequences than the wrist, if kept quiet. Diet restricted, 

as being in an inactive state. Those occurring at birth, or during 

adolescence, observe the rule formerly stated. 



PART 32 

With regard to slight congenital dislocations, some of them can be 
rectified, especially club-foot. There is more than one variety of 
club-foot. The treatment consists in modeling the foot like a piece 
of wax; applying resinous cerate, and numerous bandages; or a sole, 
or a piece of lead is to be bound on, but not upon the bare skin; 
the adjustment and attitudes to correspond. 



PART 33 

If the dislocated bones cause a wound in the skin, and protrude, it 
is better to let them alone, provided only they are not allowed to 
hang, nor are compressed. The treatment consists in applying pitched 
cerate, or compresses dipped in hot wine (for cold is bad in all such 
cases), and certain leaves; but in winter unwashed wool may be applied 
as a cover to the part; neither cataplasms nor bandaging; restricted 
diet. Cold, great weight, compression, violence, restricted position, 
all such are to be accounted as fatal measures. When treated moderately 
(they escape) , maimed and deformed; for, if the dislocation be at 
the ankle, the foot is drawn upward, and, if elsewhere, according 
to the same rule. The bones do not readily exfoliate; for only small 
portions of them are denuded, and they heal by narrow cicatrices. 
The danger is greatest in the greatest joints, and those highest up. 
The only chance of recovery is, if they are not reduced, except at 
the fingers and hand, and in these cases the danger should be announced 
beforehand. Attempts at reduction to be made on the first or second 
day; or, if not accomplished then, on the tenth, by no means on the 
fourth. Reduction by levers. Treatment : -As in injuries of the bones 
of the head, and the part is to be kept hot; and it is better to give 
hellebore immediately after the parts have been reduced. With regard 
to the other bones, it should be well known, that, if replaced, death 
will be the consequence; the more surely and expeditiously, the greater 



the articulation, and the more high its situation. Dislocation of 

the foot is attended with spasm (tetanus) and gangrene; and if, upon 

its being replaced, any of these symptoms come on, the chance of recovery, 

if there be any chance, is in displacing it anew; for spasms do not 

arise from relaxation, but from tension of the parts. 



PART 34 

Excision, either of articular bones or of pieces of bones, when not 
high up in the body, but about the foot or the hand, is generally 
followed by recovery, unless the patient die at once from deliquium 
animi . Treatment : -As in injuries of the head; warmth. 



PART 35 

Sphacelus of the fleshy parts is produced by the tight compression 
of bleeding wounds, and by pressure in the fractures of bones, and 
by blackening, arising from bandages. And in those cases in which 
a portion of the thigh or arm, both the bones and the flesh drop off, 
many recover, the case being less dangerous than many others. In cases, 
then, connected with fracture of the bones, the separation of the 
flesh quickly takes place, but the separation of the bone, at the 
boundary of its denuded part, is slower in taking place. But the parts 
below the seat of the injury, and the sound portion of the body, are 
to be previously taken away (for they die previously), taking care 
to avoid producing pain, for deliquium animi may occasion death. The 
bone of the thigh in such a case came away on the eightieth day, but 
the leg was removed on the twentieth day. The bones of the leg, in 
a certain case, came away at the middle of the sixtieth day. In these 
cases the separation is quick or slow, according to the compression 
applied by the physician. When the compression is gently applied the 
bones do not drop off at all, neither are they denuded of flesh, but 
the gangrene is confined in the more superficial parts. The treatment 
of such cases must be undertaken; for most of them are more formidable 
in appearance than in reality. The treatment should be mild, but, 
not withstanding, with a restricted diet; hemorrhages and cold are 
to be dreaded; the position, so as that the limb may be inclined upward, 
and afterward, on account of the purulent abscess, horizontally, or 
such as may suit with it. In such cases, and in mortifications, there 
are usually, about the crisis, hemorrhages and crisis, hemorrhages 
and violent diarrhoeas, which, however, only last for a few days; 
the patients do not lose their appetite, neither are they feverish, 
nor should they be put upon a reduced diet. 



PART 3 6 

Displacement of the spine, if inward, threatens immediate death, attended 
with retention of urine and loss of sensibility. Outward, the accident 
is free from most of these bad effects, much more so than where there 
is merely concussion without displacement; the effects in the former 
case being confined to the spot affected, whereas in the latter they 
are further communicated to the whole body, and are of a mortal character. 
In like manner, when the ribs are fractured, whether one or more, 
provided there be no splinters, there is rarely fever, spitting of 
blood, and sphacelus, and ordinary treatment without evacuation will 
suffice, provided there be no fever ; -bandaging, according to rule; 
and the callus forms in twenty days, the bone being of a porous nature. 
But in cases of contusion, tubercles form, along with cough, suppurating 



sores, and sphacelus of the ribs, for nerves from all the parts run 
along each rib. In many of these cases haemoptysis and empyema also 
take place. The management of this case consists in careful treatment, 
bandaging according to rule, diet at first restricted, but afterward 
more liberal, quiet, silence, position, bowels, and venereal matters 
regulated. Even when there is no spitting of blood, these contusions 
are more painful than fractures, and are more subject in time to relapses; 
and when any mucous collection is left in the part, it makes itself 
be felt in disorders of the body. Treatment : -burning, when the bone 
is affected, down to the bone, but not touching the bone itself; if 
in the intercostal space, the burning must not extend through it, 
nor be too superficial. In sphacelus of the ribs, tents are to be 
tried, all other particulars will be stated afterward: but they should 
be learned by sight rather than by words, namely, food, drink, heat, 
cold, attitude; medicines, dry, liquid, red, dark, white, sour, for 
the ulcers, and so with regard to the diet. 



PART 37 

Displacements (of the vertebrae) from a fall rarely admit of being 
rectified, and those above the diaphragm are most difficult to rectify. 
When the accident happens to children, the body does not grow, with 
the exception of the legs, the arms, and head. Excurvation, in adults, 
speedily relieves the individual from the disease he is laboring under, 
but in time it renews its attack, with the same symptoms as in children, 
but of a less serious nature. Some individuals have borne this affection 
well, and have turned out to be brawny and fat. But few of them have 
lived to the age of sixty. Lateral curvatures also occur, the proximate 
cause of which is the attitudes in which these persons lie. These 
cases have their prognostics accordingly. 



PART 3 8 

The rule for the reduction and adjustment : -The axle, the lever, the 

wedge, pressure above; the axle to separate, the lever to push aside. 

Reduction and adjustment are to be accomplished by forcible extension, 

the parts being placed in such a position as will facilitate the conveying 

of the displaced bone over the extremity of the bone from which it 

was displaced: this is to be accomplished either with the hands, or 

by suspension, or axles, or turned round something. With the hands 

this is to be effected properly, according to the structure of the 

parts. In the case of the wrist and elbow, the parts are to be forced 

asunder, at the wrist in the line of the elbow, and the elbow with 

the fore-arm at a right angle with the arm, as when it is suspended 

in a sling. When we want to separate the protruding bones, and force 

them into place, in the case of the fingers, the toes, or the wrist, 

the proper separation may be made by hands, while the projecting part 

is forced into its place by pressing down with the heel or the palm 

of the hand upon some resisting object, while something moderately 

soft is laid under the projecting part, but nothing such under the 

other, and then pressure is to be made backward and downward, whether 

the dislocation be inward or outward. In lateral displacement, pressure 

and counter-pressure must be made on the opposite sides. Displacements 

forward can be reduced neither by sneezing, nor coughing, nor by the 

injection of air, nor by the cupping-instrument; and if anything can 

do good in such a case, it is extension. People are deceived in fractures 

of the spinal processes, the pain of which causing the patient to 

stoop forward, the case is taken for dislocation inward; these fractures 

heal speedily and easily. Dislocation outward is to be remedied by 

succussion, when high up, toward the feet; and when situated low down, 



in the contrary direction; the part is to be pressed back into its 

place, either with the foot or a board. Dislocations to either side, 

if they admit of any remedy, are to be treated by extension, and suitable 

attitudes, with regimen. The whole apparatus should be broad, soft, 

and strong; or otherwise, they should be wrapped in rags; before being 

used, they should all be prepared proportionately to the length, height, 

and breadth. In applying extension to the thigh, for example, the 

bands should be fastened at the ankle and above the knee, these stretching 

in the same direction, another band to be passed by the loins, and 

around the armpits, and by the perineum and thigh, one end passing 

up the breast and the other along the back, these all stretching in 

the same direction and being fastened either to a piece of wood resembling 

a pestle or to an axle. When this is done on a couch, either of its 

feet is to be fastened to the threshold, and a strong block of wood 

is to be laid across the other, and the pieces of wood resembling 

a pestle are to be raised on these, to make extension and counter-extension; 

the naves of a wheel are to be fastened in the floor, or a ladder 

is to be adjusted, so that extension may be made in both directions. 

The thing commonly used is a bench six cubits long, two cubits broad, 

one fathom in thickness, having two low axles at this end and that, 

and having at its middle two moderate sized pillars, to which is to 

be adjusted a transverse piece of wood like the step of a ladder, 

which is to receive the piece of wood tied below the limb, as is done 

in dislocation at the shoulder; and the bench is to have excavations 

like trays, smooth, four inches in breadth and depth, and at such 

an interval as to leave room for the lever used to reduce the limb. 

In the middle of the bench a square hole is to be scooped out to receive 

a small pillar, which, being adjusted to the perineum, will obviate 

the tendency of the body to slip downward, and being rather loose 

may act somewhat as a lever. In certain occasions a piece of wood 

is required, which is inserted into a hole scooped out of the wall; 

the other end of it is then to be pressed down, something moderately 

soft being placed under it. 



PART 3 9 

In those cases where the bone of the palate has exfoliated, the nose 
sinks in its middle. In contusions of the head without a wound, either 
from a fall, a fracture, or pressure, in certain of these cases acrid 
humors descend from the head to the throat, and from the wound in 
the head to the liver and thigh. 



PART 4 

The symptoms of subluxations and luxations, and where, and how, and 

how much these differ from one another. And the cases in which the 

articular cavity has been broke off, and in which the ligament has 

been torn, and in which the epiphysis has broken in which, and how, 

when the limb consists of two bones, one or both are broken: in consequence 

of these the dangers, chances in which bad, and when the injuries 

will result in death, and when in recovery. What cases are to be reduced 

or attempted, and when, and which, and when not; the hopes and dangers 

in these cases. Which and when congenital dislocations are to be undertaken: 

the parts in a state of growth, the parts fully grown, and why sooner, 

or slower: and why a part becomes maimed, and how, and how not: and 

why a certain part is atrophied, and where, and how, and in what cases 

to a less extent. And why fractured parts unite sooner or slower, 

how distortions and callosities form, and the remedy for them. In 

what cases there are external wounds, either at first or afterwards: 

in what fractures the bones are shortened, and in what not: in what 



cases the fractured bones protrude, and when they protrude most: in 
what cases dislocated bones protrude. That physicians are deceived, 
and by what means, in what they see, and in what they devise, regarding 
affections, and regarding cures. Established rules with regard to 
bandaging: preparation, presentation of the part, extension, adjustment, 
friction, bandaging, suspension and placing of the limb, attitude, 
seasons, diet. The more porous parts heal fastest, and vice versa. 
Distortions, where the bones are crooked. Flesh and tendons wasted 
on the side of the dislocation. The force used in reduction to be 
applied at as great a distance as possible from the seat of the displacement. 
Of nerves (ligaments?), those which are in motion and in humidity 
(flabby?) are of a yielding nature; those that are not, less so. In 
every dislocation the most speedy reduction is best. Reduction not 
to be made while the patient is in a febrile state, nor on the fourth 
or fifth day; and least of all, in those of the elbow, and all cases 
which induce torpor; the soonest the best, provided the inflammatory 
stage be avoided. Parts torn asunder, whether nerves, or cartilages, 
or epiphyses, or parts separated at symphyses, cannot possibly be 
restored to their former state; but callus is quickly formed in most 
cases, yet the use of the limb is preserved. Of luxations, those nearest 
the extremities are least dangerous. Those joints which are most easily 
dislocated are the least subject to inflammation. Those which have 
been least inflamed, and have not been subjected to after-treatment, 
are most liable to be dislocated anew. Extension should be made in 
the position most calculated to enable the one bone to clear the extremity 
of the other, attention being paid to configuration and place. Adjustment 
to be made in the direction of the displacement; to push the displaced 
limb straight backward and sideways. Parts suddenly drawn aside are 
to be suddenly drawn back by a rotatory motion. Articulations which 
have been oftenest dislocated are the most easily reduced; the cause 
is the conformation of the nerves (ligaments?) or of the bones; of 
the ligaments that they are long and yielding; and of the bones, the 
shallowness of the articular cavity, and roundness of the head [of 
the bone that enters it] . Usage, by its friction, forms a new socket. 
The cause-the disposition, and habit, and age. A part somewhat mucous 
is not subject to inflammation. 



PART 41 

In those cases where there are wounds, either at first, or from protrusion 

of the bones; or afterwards, from pruritus, or irritation; in the 

latter case you are immediately to unloose the bandages, and having 

applied pitched cerate to the wound, bandage the limb, placing the 

head of the roller upon the wound, and proceeding otherwise as if 

there were no wound in the case; for thus will the swelling be reduced 

as much as possible, and the wound will suppurate most quickly, and 

the diseased parts will separate, and when it becomes clean the wound 

will most quickly heal. Splints are not to be applied to the place, 

nor is it to be bound tight. Proceed thus when no large bones exfoliate, 

but not in the latter case, for then there is great suppuration, and 

the same treatment is not applicable, but the parts require to be 

exposed to the air on account of the abscesses. In such cases where 

the bones protrude, and whether reduced or not, bandaging is not befitting, 

but distention is to be practiced by means of rolls of cloth, made 

like those used upon shackles; one of these is to be placed at the 

ankle, and the other at the knee; they are to be flattened toward 

the leg, soft, strong, and having rings; and rods made of cornel, 

and of a proper length and thickness are to be adjusted to them, so 

as to keep the parts distended; and straps, attached to both extremities, 

are to be inserted into the rings, so that the extremities being fixed 

into the rolls, may effect distention. Treatment : -Pitched cerate, 

in a hot state; the attitudes, position of the foot and hip; regulated 



diet. The bones which have protruded through the skin are to be replaced 
the same day, or next; not on the fourth or fifth, but when the swelling 
has subsided. Reduction is to be performed with levers; when the bone 
does not present any place upon which the lever can rest, a portion 
of the part which prevents this is to be sawed off. But the denuded 
parts will drop off, and the limb become shortened. 



PART 4 2 

Dislocations at the joints are to a greater and less extent. Those 
that are to a less extent are the most easily reduced; those that 
are to a greater extent occasion lesions of the bones, of the ligaments, 
of the joints, of the fleshy parts, and of the attitudes. The thigh 
and arm resemble one another very much in their dislocations. 

THE END